Kelly, Sarah A. M., Hartley, Louise, Loveman, Emma, Colquitt, Jill L, Jones, Helen M, Al-Khudairy, Lena, Clar, Christine, Germanò, Roberta, Lunn, Hannah R., Frost, Gary and Rees, Karen (2017) Whole grain cereals for the primary or secondary prevention of cardiovascular disease. Cochrane Database of Systematic Reviews (8). CD005051. doi:10.1002/14651858.cd005051.pub3 ISSN 1469-493X.

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Abstract

Background:
There is evidence from observational studies that whole grains can have a beneficial effect on risk for cardiovascular disease (CVD). Earlier versions of this review found mainly short-term intervention studies. There are now longer-term randomised controlled trials (RCTs) available. This is an update and expansion of the original review conducted in 2007.

Objectives:The aim of this systematic review was to assess the effect of whole grain foods or diets on total mortality, cardiovascular events, and cardiovascular risk factors (blood lipids, blood pressure) in healthy people or people who have established cardiovascular disease or related risk factors, using all eligible RCTs.

Search methods:
We searched CENTRAL (Issue 8, 2016) in the Cochrane Library, MEDLINE (1946 to 31 August 2016), Embase (1980 to week 35 2016), and CINAHL Plus (1937 to 31 August 2016) on 31 August 2016. We also searched ClinicalTrials.gov on 5 July 2017 and the World Health Organization International Clinical Trials Registry Platform (WHO ICTRP) on 6 July 2017. We checked reference lists of relevant articles and applied no language restrictions.

Selection criteria:
We selected RCTs assessing the effects of whole grain foods or diets containing whole grains compared to foods or diets with a similar composition, over a minimum of 12 weeks, on cardiovascular disease and related risk factors. Eligible for inclusion were healthy adults, those at increased risk of CVD, or those previously diagnosed with CVD.

Data collection and analysis:
Two review authors independently selected studies. Data were extracted and quality-checked by one review author and checked by a second review author. A second review author checked the analyses. We assessed treatment effect using mean difference in a fixed-effect model and heterogeneity using the I2 statistic and the Chi2 test of heterogeneity. We assessed the overall quality of evidence using GRADE with GRADEpro software.

Main results:
We included nine RCTs randomising a total of 1414 participants (age range 24 to 70; mean age 45 to 59, where reported) to whole grain versus lower whole grain or refined grain control groups. We found no studies that reported the effect of whole grain diets on total cardiovascular mortality or cardiovascular events (total myocardial infarction, unstable angina, coronary artery bypass graft surgery, percutaneous transluminal coronary angioplasty, total stroke). All included studies reported the effect of whole grain diets on risk factors for cardiovascular disease including blood lipids and blood pressure. All studies were in primary prevention populations and had an unclear or high risk of bias, and no studies had an intervention duration greater than 16 weeks.

Overall, we found no difference between whole grain and control groups for total cholesterol (mean difference 0.07, 95% confidence interval -0.07 to 0.21; 6 studies (7 comparisons); 722 participants; low-quality evidence).

Using GRADE, we assessed the overall quality of the available evidence on cholesterol as low. Four studies were funded by independent national and government funding bodies, while the remaining studies reported funding or partial funding by organisations with commercial interests in cereals.

Authors' conclusions:
There is insufficient evidence from RCTs of an effect of whole grain diets on cardiovascular outcomes or on major CVD risk factors such as blood lipids and blood pressure. Trials were at unclear or high risk of bias with small sample sizes and relatively short-term interventions, and the overall quality of the evidence was low. There is a need for well-designed, adequately powered RCTs with longer durations assessing cardiovascular events as well as cardiovascular risk factors.

Item Type:	Journal Article
Subjects:	R Medicine > RC Internal medicine
Divisions:	Faculty of Science, Engineering and Medicine > Medicine > Warwick Medical School > Health Sciences Faculty of Science, Engineering and Medicine > Medicine > Warwick Medical School > Health Sciences > Population, Evidence & Technologies (PET) Faculty of Science, Engineering and Medicine > Medicine > Warwick Medical School > Health Sciences > Statistics and Epidemiology Faculty of Science, Engineering and Medicine > Medicine > Warwick Medical School
SWORD Depositor:	Library Publications Router
Library of Congress Subject Headings (LCSH):	Cardiovascular system -- Diseases -- Prevention, Cereals as food, Systematic reviews (Medical research)
Journal or Publication Title:	Cochrane Database of Systematic Reviews
Publisher:	John Wiley & Sons Ltd.
ISSN:	1469-493X
Official Date:	24 August 2017
Dates:	Date Event 24 August 2017 Published 24 August 2017 Accepted
Number:	8
Article Number:	CD005051
DOI:	10.1002/14651858.cd005051.pub3
Status:	Peer Reviewed
Publication Status:	Published
Reuse Statement (publisher, data, author rights):	** From Crossref via Jisc Publications Router. ** Licence for this article starting on 24-08-2017: http://onlinelibrary.wiley.com/termsAndConditions
Access rights to Published version:	Open Access (Creative Commons)
Date of first compliant deposit:	13 October 2017
Date of first compliant Open Access:	24 August 2018
Funder:	Warwick Medical School, University of Teesside, Hammersmith Hospital, National Institute for Health Research (Great Britain) (NIHR), Collaborations for Leadership in Applied Health Research and Care (CLAHRC), University Hospitals Birmingham NHS Foundation Trust

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